Inflammatory bowel disease, or IBD, are a group of chronic gastrointestinal disorders in which people have ulceration, inflammation, and bleeding of their gastrointestinal tract, and are at risk for complications in other parts of the body. The two main subtypes are Crohn’s disease and ulcerative colitis. People with IBD have an elevated risk of mental illness, especially anxiety and depression, potentially related to the inflammation in the gut affecting their brain. A study published today in the journal Gut shows that women with inflammatory bowel disease are at greater risk of developing a mental illness after giving birth compared to the overall population. Study authors found that more than one-fifth of pregnant women with IBD had a new-onset mental health diagnosis. For every 43 pregnancies, there is one extra case of mental illness in a woman with IBD, compared to other women. The study used healthcare data on women who gave birth between 2002 and 2014 in Ontario, Canada to analyze the frequency of a new mental illness diagnosis in these women during and up to one year after a pregnancy.
In the study population, pregnant women with IBD had an elevated risk of developing a new-onset mental illness postpartum when compared to women without IBD – 22.7% compared to 20.4%. The women with IBD were at increased risk of two out of the four mental illness diagnostic categories: mood disorders (such as anxiety and depression) and substance use disorders (such as opioid dependency). These women were primarily treated by doctors in the outpatient setting, and did not need to be hospitalized. There was no evidence of increased risk for psychotic disorders (such as schizophrenia or hallucinations). The risk appeared elevated in women with Crohn’s disease, but not ulcerative colitis. The reason of this phenomenon is not known neither has been explored int he present reaserch. Since Crohn’s disease and ulcerative colitis share differences in women vs. men prevalence, along with a likely different pattern of microbiota composition shift, one might hypothise that either hormonal and microbial factors could lay beneath this aspect.
It is, indeed, well recognized that microbial communities in the gut (microbioma) may undergo unbalancing in autoimmune conditions, like IBDs, though no clarification still is established if the dysbiosis is the cause itself or is a result of the autoimmunity. Gut dysbiosis is well recognized as a main player in change of brain chemistry, due to the extensive metabolic interplay between microbial metabolism and neurotransmitters network. Many bacterial metabolites (tryptamine, phenols, butyric acid, ecc.) are indeed able to affect neuronal function. It’s the delicate balance between gut commmunities and immune system that keeps healthy the brain chemistry ultimately. No wonder, therefore, that women with Crohn’s disease that face pregnancy may develop further imbalance between hormones and inflammatory cytokines involved in the disease. Though immune system is usually depressed in pregnancy for a logical reason, this does not mean that cytokines will hold a brake toward tissues other than placenta and the fetus. And cytokines have been proven to play a role in psychiatric conditions, like depression itself, restless leg syndrome and bipolar disorder.
Dr. Eric Benchimol, senior author on the paper, and Senior Scientist at the CHEO Research Institute, Associate Professor of Pediatrics and Epidemiology at the University of Ottawa, and a Pediatric Gastroenterologist at the CHEO Inflammatory Bowel Disease Centre, stressed the underlying threat under this category of patients. He said: “There’s increasing awareness about mental illness in women during pregnancy and postpartum. Because of the elevated risk of mental illness in people with IBD, we felt it was important to study if women with IBD were at greater risk of developing a new mental illness during pregnancy and after giving birth, compared to the overall population. We found the risk to be elevated during the post-partum period for women with IBD, particularly in the first 90 days after birth. We did not find an elevated risk during pregnancy. Women with IBD face increased health challenges during pregnancy and after giving birth, and it’s not just physical challenges. We need to look at both the physical and mental health needs of women and ensure they are getting the best treatment and support.”
Mina Mawani, President and CEO of Crohn’s and Colitis Canada, expressed more direct and practical concerns: “These findings are very important for both patients and healthcare providers in the IBD community. If a pregnant woman with IBD knows that there’s an elevated risk of mental illness during the post-partum period, she should discuss this potential risk with her healthcare provider. It’s important that healthcare providers are aware of this increased risk in women with IBD. Together, women and their healthcare providers can look for opportunities to prevent mental illness during pregnancy and after birth as well as identify and treat it earlier.”
- edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Vigod SN, Kurdyak P et al., Benchimol E. Gut 2019 Jan 9.
Hood MM et al. Int J Behav Med. 2018 Oct; 25(5):517-525.
Becker J et al. Int J Colorectal Dis. 2018 Jul; 33(7):955-962.